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Health Technology Assessments by the National Institute for Health and Clinical Excellence - A Qualitative Study
Michael Schlander
Verlag Springer-Verlag, 2007
ISBN 9780387719962 , 245 Seiten
Format PDF
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Foreword I
6
Foreword II
8
Preface
9
Acknowledgments
11
1 Introduction
27
National Institute for Health and Clinical Excellence (NICE)
27
Attention-Deficit/Hyperactivity Disorder (ADHD)
32
2 A Note on Objectives and Methods
45
Objectives
45
Accountability for Reasonableness
45
Methods
47
Limitations
48
3 NICE Appraisal Process
50
Scoping
50
Assessment
52
Appraisal
56
Appeal
56
Clinical Guidelines
57
4 NICE Appraisal of ADHD Treatments
59
Scope
59
Assessment
60
Appraisal
61
Appeal
63
Clinical Guidelines
64
5 NICE Appraisal of ADHD Treatment Options: A Critique
67
Scoping
69
Data Selection for Assessment
71
Outcome Measures
74
Quality of Life and Utility Estimates
77
Selection of Clinical Effectiveness Studies for Economic Evaluation
81
Efficacy, Effectiveness, and Treatment Compliance
90
Internal Versus External Validity of Clinical Trials
91
Quantitative Evidence on Treatment Compliance
94
Treatment Compliance of Patients with ADHD
95
Data Synthesis Across Endpoints and Studies
100
Data Synthesis Across Endpoints
111
Data Synthesis Across Clinical Studies
113
Economic Model
116
Literature Review
117
Structure of the Model
118
Economic Model Results
125
Appraisal and Appeal Process
130
6 Discussion and Implications
136
The Case Study
136
Insights from Clinical Long-Term Studies
140
Insights from Disease-Specific Effectiveness Measures
148
Case Analysis: Symptoms and Underlying Problems
163
Separation of Clinical and Economic Perspectives
165
High Level of Standardization
166
Technical Quality of Assessment
169
Process-Related Issues
170
NICE Accountability for Reasonableness
171
Publicity
171
Relevance
174
Appeal
176
Enforcement
177
NICE Technology Appraisal No. 98 -- A Unique Outlier?
178
Implications for International Health Care Policy-Makers
180
Objectives of Health Care Provision
180
(Almost) Exclusive Reliance on QALYs as Outcome Measure?
182
Technology Appraisal Processes
182
Timing of Technology Appraisals
184
Multidisciplinary Assessment Teams
184
Quality Assurance
185
Implementation
185
7 Which Way Forward?
189
Starting Points
189
Affordability
191
Institutional Context
193
Objectives, Reconsidered
195
Efficiency
195
Fairness
198
Research Agenda
200
Final Note
202
Appendix AAbbreviations and Use of Terminology
204
Appendix BCritical Gaps of Assessment
208
Appendix CConsistency Issues Associated with NICE Assessment
212
References
220
About the Author
252
About the Author
1
Index
253
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